Marc Ryan

BCBS KC Will Exit Medicare Advantage Blue Cross and Blue Shield Kansas City has announced it will exit the Medicare Advantage (MA) program.  This shows the challenges created by some poor decisions by the Centers for Medicare and Medicaid Services (CMS).  I had said that many regional plans would pick up lives as major plans offload them due to investor concerns.  Will this be a trend or an exception? #medicareadvantage #coverage #cms https://www.fiercehealthcare.com/payers/blue-kc-exiting-medicare-advantage-market-2025-due-regulatory-demands Cigna Layoffs Cigna’s Evernorth services arm will lay off some specialty health center employees in favor of a focus on primary care. (Article may require a subscription.) #cigna #evernorth #healthcare #layoffs https://www.modernhealthcare.com/insurance/cigna-evernorth-care-layoffs-closings CVS Searching For Investment Partner For Oak Street This article speculates a good deal on CVS Health’s search for an investment partner to expand Oak Street, its primary care arm. (Article may require a subscription.) #cvshealth #primarycare https://www.modernhealthcare.com/providers/cvs-health-oak-street-private-equity-investment Grassley Wants To Understand Ascenion’s Ties To

HHS Clarifies Responsibility For Change Healthcare Breach Notifcation The Department of Health and Human Services (HHS) announced today that UnitedHealth Group would inform people about privacy breaches resulting from the Change Healthcare cyberattack. Providers, payers, and others may direct United to do so.  Previous guidance was ambiguous.  HHS FAQs were updated and clarified the issue. HHS FAQs: https://www.hhs.gov/about/news/2024/05/31/ocr-updates-change-healthcare-cybersecurity-incident-faqs.html (Some articles may require a subscription.) #changehealthcare #cyberattacks #providers #payers https://www.modernhealthcare.com/cybersecurity/change-healthcare-hack-notification-requirements-hhs Centene Also Reports Pressure on Medicaid Finances On the tail of United, Centene is now reporting significant medical expense pressure tied to the Medicaid disenrollment due to the return of Medicaid redeterminations.  The article discusses that other plans are not seeing severe pressure.  It also discusses Medicare Advantage (MA) financial problems. Medicaid plans had received relief in the form of higher rates during COVID, but as I noted earlier state revenue is drying up and might spell issues for Medicaid managed

Big Blue Highmark Sees Bad Trends in Medicare Advantage Pennsylvania-based Big Blue Highmark Health says it is seeing the same sort of Medicare Advantage (MA) trends other plans have reported. It sees increased utilization across inpatient and outpatient as well as rising costs of GLP-1 drugs. #highmark #medicareadvantage #weightlossdrugs https://www.fiercehealthcare.com/payers/highmark-health-seeing-medicare-advantage-and-glp-1-headwinds What Would GOP And Trump Healthcare Agenda Look Like? Many are readying for a new Trump administration and looking at what healthcare policy changes could occur.  Many say that the GOP will not go for a full repeal of the Affordable Care Act (ACA), but that enhanced subsidies will die at the end of 2025. The GOP might not fully repeal Medicare drug negotiations, but tweak the law.  Trump, too, could revive international reference pricing in Part B and perhaps in Part D. This is where Trump and Biden look a lot alike. The biggest changes could come with Medicaid,